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Pioneering work in defining brainstem safe entry zones and development of surgical techniques has made microsurgical removal of brainstem cavernous malformation possible. 1,2 The middle cerebellar peduncle (MCP) is a robust route for access to deep-seated lesions within the pons. The peduncle can be accessed by splitting the petrosal fissure of the cerebellum to obtain a more direct view to the MCP through a retrosigmoid approach. The author presents a case of a female with a history of 3 bleeds attributable to a giant pontine cavernous malformation. The patient consented to the procedure. Given the aggressive natural history of deep cavernous malformations, especially in the year following a bleed, surgical removal was recommended. Step-by-step description of access to the MCP through splitting the petrosal fissure, and key steps for removal of a pontine cavernous malformation are described.
M. Yashar S. Kalani (Fri,) studied this question.